Levin Harvey S, Hanten Gerri, Roberson Garland, Li Xiaoqi, Ewing-Cobbs Linda, Dennis Maureen, Chapman Sandra, Max Jeffrey E, Hunter Jill, Schachar Russell, Luerssen Thomas G, Swank Paul
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.
J Neurosurg Pediatr. 2008 Jun;1(6):461-70. doi: 10.3171/PED/2008/1/6/461.
The aim of this study was to determine whether the presence of intracranial pathophysiology on computed tomography (CT) scans obtained within 24 hours of mild traumatic brain injury (MTBI) in children adversely affects neuropsychological outcome during the 1st year postinjury.
A prospective longitudinal design was used to examine the neuropsychological outcomes in children (ages 5-15 years) who had been treated for MTBI, which was defined as a loss of consciousness for up to 30 minutes and a lowest Glasgow Coma Scale (GCS) score of 13-15. Exclusion criteria included any preinjury neurological disorder. Outcome assessments were performed within 2 weeks and at 3, 6, and 12 months postinjury. Outcomes were compared between patients with MTBI whose postinjury CT scans revealed complications of brain pathophysiology (32 patients, CMTBI group) and those with MTBI but without complications (48 patients, MTBI group).
Significant interactions confirmed that the pattern of recovery over 12 months after injury differed depending on the intracranial pathology, presence and severity of injuries to body regions other than the head, preinjury attention-deficit hyperactivity disorder (ADHD), and socioeconomic status. Children in the CMTBI group had significantly poorer episodic memory, slower cognitive processing, diminished recovery in managing cognitive interference, and poorer performance in calculating and reading than patients in the MTBI group. Among the patients with mild or no extracranial injury, visuomotor speed was slower in those in the CMTBI group; and among patients without preinjury ADHD, working memory was worse in those in the CMTBI group.
Neuropsychological recovery during the 1st year following MTBI is related to the presence of radiographically detectable intracranial pathology. Children with intracranial pathology on acute CT performed more poorly in several cognitive domains when compared with patients whose CT findings were normal or limited to a linear skull fracture. Depending on the presence of preinjury ADHD and concomitant extracranial injury, working memory and visuomotor speed were also diminished in patients whose CT findings revealed complications following MTBI. Computed tomography within 24 hours postinjury appears to be useful for identifying children with an elevated risk for residual neuropsychological changes.
本研究旨在确定儿童轻度创伤性脑损伤（MTBI）后24小时内计算机断层扫描（CT）显示的颅内病理生理学改变是否会对损伤后第1年的神经心理学结局产生不利影响。
采用前瞻性纵向设计，对接受MTBI治疗的儿童（5 - 15岁）的神经心理学结局进行检查，MTBI定义为意识丧失长达30分钟且格拉斯哥昏迷量表（GCS）最低评分为13 - 15分。排除标准包括任何伤前神经系统疾病。在损伤后2周以及3、6和12个月进行结局评估。对损伤后CT扫描显示脑病理生理学并发症的MTBI患者（32例，CMTBI组）和无并发症的MTBI患者（48例，MTBI组）的结局进行比较。
显著的交互作用证实，损伤后12个月的恢复模式因颅内病变、头部以外身体部位损伤的存在和严重程度、伤前注意缺陷多动障碍（ADHD）以及社会经济地位而异。CMTBI组儿童的情景记忆明显较差，认知处理速度较慢，在处理认知干扰方面恢复较慢，计算和阅读能力比MTBI组患者差。在轻度或无颅外损伤的患者中，CMTBI组患者的视觉运动速度较慢；在无伤前ADHD的患者中，CMTBI组患者的工作记忆较差。
MTBI后第1年的神经心理学恢复与影像学可检测到的颅内病变有关。与CT结果正常或仅限于线性颅骨骨折的患者相比，急性CT显示颅内病变的儿童在几个认知领域表现更差。根据伤前ADHD的存在和伴随的颅外损伤情况，MTBI后CT结果显示有并发症的患者的工作记忆和视觉运动速度也会降低。损伤后24小时内的计算机断层扫描似乎有助于识别残留神经心理学改变风险较高的儿童。
